PDB41 Impact of Sustained Hemoglobin A1C Control on Health Care Costs Among Patients With Diabetes in Hawaii

Abstract

OBJECTIVES:To estimate the clinical and economic impact of saxagliptin (SAXA) versus sulfonylurea (SU), both with metformin (MET), on the reduction of hypoglycemia among individuals with type 2 diabetes (T2D) in clinical practice. METHODS: Our analysis combined data from several sources to estimate outcomes on a perpatient and health plan-population level. Patient survey data (nϭ91) were used to estimate real-world rates of hypoglycemia for patients treated with SUϩMET, while the relative risk reduction observed in the pivotal SAXA clinical trial was applied to estimate the proportion of patients receiving SAXAϩMET who experience Ն1 hypoglycemia event. Costs associated with hypoglycemia treatment were obtained from an administrative claims analysis (nϭ813) and epidemiologic data were obtained from the literature. Costs are reported in 2011 USD. RESULTS: Treatment with SAXAϩMET was estimated to reduce the probability of experiencing Ն1 event from 68.1% to. 5.6% (net -62.5%). At these rates, resultant annual costs when all diabetes-related medical claims were considered were $435/patient treated with SUϩMET and $36/patient treated with SAXAϩMET, an annual cost savings of $399/patient receiving SAXAϩMET. If 50% of eligible patients in a 100,000-member health plan were switched from SUϩMET to SAXAϩMET, the net diabetes-related cost savings due to reduced hypoglycemia was estimated at ϳ$216,000 in 2011, increasing to ϳ$230,000 by 2013 (net savings of ϳ$0.19 per-member-per-month). When only confirmed events [i.e., symptom(s) ϩ blood glucose Ͻ70mg/dL] were considered, the net reduction in event rate was -24.2%, with annual cost savings predicted at $209/patient or ϳ$113,000-121,000 on a health plan level (savings of ϳ$0.10 per-member-per-month). CONCLUSIONS: When clinical trial results for SAXAϩMET are translated to actual clinical practice, the model predicts the lower rate of hypoglycemia (considering all events as well as confirmed events only) relative to treatment with SUϩMET will result in considerable cost savings on both a per-patient and health-plan level. OBJECTIVES:To examine the relationship between sustained glycemic control and health care costs among patients with diabetes with an initial hemoglobin A1c (HbA1c)Ͼ9%. METHODS: We conducted a retrospective analysis of administrative data from patients with diabetes and initial poor HbA1c control enrolled in a large health plan in Hawai'i (nϭ1304). We used propensity scores to identify a comparable cohort based on age, gender, type of coverage, diabetes duration, number of medications, location of residence, comorbidity conditions, and morbidity level. We examined the relationship between reduced HbA1c values and costs in the same year as well as the impact of achieving sustained HbA1c control (at Ͻ 7%) for three years on changes in health care costs using generalized linear models. RESULTS: In cross-sectional comparisons, the average annual direct medical costs for patients with a HbA1c less than 7% was $14,821 compared to $12,108 for the A177

Cost-utility of medication withdrawal in older fallers: results from the improving medication prescribing to reduce risk of FALLs (IMPROveFALL) trial

“…Moreover, economic evaluations on falls prevention are scarce. However, evidence from reviews targeting economic evaluation studies of single factor falls prevention interventions like exercise programs [28, 29] and multifactorial falls prevention interventions [30] is promising.…”